EAU CLAIRE — With more than 200,0000 Americans killed by COVID-19 so far this year, the pandemic justifiably has attracted much of the nation’s attention.
But while seemingly all eyes were focused on the coronavirus threat, the opioid epidemic never went away.
The harsh reality, health officials warn, is that the isolation and stress that go along with COVID-19 have made life even more difficult for those struggling with opioid addiction, both nationally and in the Chippewa Valley.
“The worsening of the opioid epidemic within the pandemic is certainly a mental health crisis and a public health crisis within a crisis,” said Dr. Cynthia Townsend, a clinical health psychologist at Mayo Clinic.
In Wisconsin and the Chippewa Valley, the numbers since the start of the pandemic make clear that the opioid epidemic continues to wreak havoc even as it has become a back-burner issue for many.
Suspected opioid overdose emergency department visits totaled 2,390 statewide from March through September, up 39% from 1,717 during the same period last year, according to statistics from the Wisconsin Department of Health Services.
The increase was even higher in Eau Claire, Chippewa and Dunn counties, soaring 50% from 22 suspected opioid overdose emergency department visits during March through September in 2019 to 33 in the same seven months of this year.
Thirteen people in the Chippewa Valley and 656 statewide have died from opioid overdoses so far this year, according to preliminary DHS data.
Toni Simonson, executive director of behavioral health for HSHS Sacred Heart and St. Joseph’s hospitals and the L.E. Phillips-Libertas Treatment Center in Chippewa Falls, sees the impact of the twin crises daily at the local facilities.
The requirements for social distancing amid the COVID-19 pandemic are hard on everybody because people are by nature social beings, but increased isolation has been particularly difficult for individuals in recovery from drug addiction, Simonson said.
“When people are not able to get out and about and attend treatment, they’re definitely using more,” she said.
Not only are some support groups no longer meeting in person to reduce the risk of spreading the virus, but concerns about potential coronavirus exposure may make some individuals anxious about seeking help if their drug use is spinning out of control or they are in danger of relapsing.
“As a result, when they come in for help, they’re even sicker,” Simonson said.
In addition, screening and testing requirements for COVID-19 have made it more difficult for doctors to get patients into inpatient or residential care for addiction, said Paul Horvath, an emergency medicine physician at Mayo Clinic Health System in Eau Claire.
Stress also can be a relapse trigger for people in recovery.
“There are a lot of reasons why individuals are having a worse time with addiction during this crisis,” said Dr. Halena Gazelka, a Mayo Clinic anesthesiologist specializing in pain management and chair of the Mayo Clinic Opioid Stewardship Program. “We know from studies in the past that during times of economic downturn and job loss and fear and uncertainty, the addiction rates go up and there are more issues with overdose and morbidity from addictive behaviors.”
Gazelka and Townsend called attention to the continuing opioid crisis during a virtual presentation this week for reporters, with Gazelka noting that U.S. deaths from COVID-19 are “not the only tragedies that have occurred in this truly unfathomable experience that we are living through.”
Individuals using opioids also are more at risk of death in the event of an overdose if no one else is home to call 911 or administer the overdose-reversal medication naloxone, Gazelka added.
The uncertainty and scope of COVID-19 has required an emotional fortitude that has been a struggle even for the most resilient people, Townsend said, adding that the pandemic has permeated all of her conversations with patients over the last several months.
Meeting that challenge can be even more difficult for people struggling with addiction.
“Imagine, in this COVID time when there is so much to manage, having this on top of it,” Townsend said. “Our human urge is to do something to rebalance internal turmoil, whether it is something that feels good, exciting, or the exact opposite, something that makes you feel less bad, less anger, less anxiety, less depression, and maybe numbing and coping. That’s when we start to see the efforts to rebalance with substances.”
Factors the health officials cited for the worsening opioid epidemic are more patients reluctant or unable to visit doctors for legitimate pain management during the pandemic. Others include people who are unable to use technology to access telehealth resources and an interruption of illegal drug supply networks that research shows has led to increased overdose risk for people buying opioids increasingly laced with fentanyl and other synthetic substances. Fentanyl is 50 times more potent than heroin and 100 times stronger than morphine, according to the U.S. Centers for Disease Control and Prevention.
The American Medical Association recently expressed concern that more than 40 states have reported increases in opioid-related deaths, particularly from illicitly manufactured fentanyl.
So many stressful factors coming together at the same time create a perfect storm of risk for people in recovery from opioid abuse, Simonson said.
“We have a convergence of two major health issues in our community, COVID and the opioid epidemic, and they are growing together,” Simonson said.
The growth in opioid treatment demand has exceeded capacity in recent years in the Chippewa Valley, with Prevea Health opening medication-assisted treatment clinics two years ago with slots for 30 people and already more than quintupling that to 170.
“We can’t keep up,” Simonson said. “We don’t have the capacity for all of the requests that come in for that program.”
Likewise, she said, opioids now account for about half of detoxification patients at the Libertas Treatment Center, compared with just 10% four years ago.
Through the concurrent crises, other than a brief pause early in the summer, Mayo Clinic has continued to increase efforts and resources to help providers prescribe opioids safely and to study prescribing patterns, said Terrence Witt, a family practice physician at Mayo Clinic Health System in Eau Claire and member of the Mayo Clinic Opioid Stewardship Program Oversight Group.
While providers can help patients by working with them to maintain access to services, Simonson said, individuals dealing with addiction issues can help themselves by staying connected to their support network and doing their best to follow daily routines and establish healthy distractions from the day-to-day anxieties associated with the pandemic.
Paul Krupski, director of opioid initiatives at DHS, said in a news release this summer that COVID-19 hit Wisconsin just as the state was making strides in reducing the number of deaths from opioids. He encouraged people to educate themselves on the signs of substance abuse disorder so they can offer assistance to those at risk of overdose.
“I think that we have a long haul ahead of us,” Simonson said, “and we’re going to have to be creative in how to meet the needs of the community on not just COVID-19 but on the opioid epidemic, which isn’t going away.”